RESUMO
RESUMEN Antecedentes: Las hernias de línea media asociadas a diástasis de los músculos rectos anteriores (DRA) son frecuentes y se ha propuesto el tratamiento de ambas patologías simultáneamente para reducir la recurrencia. Las técnicas mínimamente invasivas permiten el tratamiento adecuado con reducción de complicaciones asociadas a la herida quirúrgica; sin embargo, aún no hay consenso acerca de cuál es la mejor técnica. Objetivo: Evaluar los resultados posoperatorios a corto y mediano plazo de una serie de pacientes con defectos de línea media y DRA tratados con la técnica Trans-umbilical Endoscopic Sublay Repair (TESuR). Material y método: Se realizó un estudio observacional descriptivo retrospectivo de pacientes a quienes se les aplicó técnica TESuR entre diciembre de 2020 y marzo de 2023, con un seguimiento posoperatorio mínimo de 6 meses. Se analizaron variables demográficas y perioperatorias. Resultados: En el período de estudio se realizaron 24 reparaciones. Todos los pacientes fueron varones. La edad promedio fue de 57 años (rango 41-81) y el índice de masa corporal (IMC) de 28,9 (21,7- 36,1) kg/m². El área del defecto fue de 8,8 (4-25) cm2, con una DRA de 5,1 (3-9) cm. La tasa de complicaciones a 30 días posoperatorios alcanzó el 17% (4/24); todas fueron Clavien-Dindo I. Con un promedio de seguimiento de 18,6 meses (rango 6-25) no se detectaron recidivas herniarias, aunque dos pacientes (8%) presentaron recidiva de la DRA. Conclusiones: La técnica TESuR presentó una baja morbilidad sin recidivas, por lo que la consideramos una alternativa segura y eficaz para el tratamiento de la DRA asociada a defectos de la línea media.
ABSTRACT Background: Midline hernias associated with diastasis recti abdominis (DRA) are common. Simultaneous treatment of both conditions has been recommended to reduce recurrence. Minimally invasive techniques allow adequate treatment while reducing surgical site complications. However, there is still no consensus regarding the optimal technique. Objective: The aim of this study was to evaluate the short and mid-term outcomes of Trans-umbilical Endoscopic Sublay Repair (TESuR) in patients with midline defects and DRA. Material and methods: We conducted a retrospective descriptive observational study of patients undergoing TESuR between December 2020 and May 2023, with a minimum postoperative follow-up of 6 months. The demographic and perioperative variables were analyzed. Results: A total of 24 procedures were performed during the study period. All the patients were men. Mean age was 57 years (range 41-81) and body mass index (BMI) was 28.9 (21.7- 36.1) kg/m². Mean size of the defect was 8.8 cm2 (4-25) with a mean diastasis width of 5 cm (3-9). The rate of complications at 30 days was 17% (4/24) and were all are grade 1 of the Clavien-Dindo classification. After a mean follow-up of 18.6 months (range 6-25), there were no hernia recurrences, although 2 patients (8%) had a recurrence of DRA. Conclusions: TESuR showed low morbidity rate and absence of recurrences, constituting a safe and effective option for the management of DRA associated with midline defects.
RESUMO
BACKGROUND: Laparoscopic appendectomy (LA) is a common procedure among surgical trainees. However, first-year residents' involvement in this procedure is scarcely studied. We aimed to determine the safety and outcomes of LA performed by surgical interns early in their first year of surgical training. MATERIALS AND METHODS: A retrospective review of all patients who underwent LA for acute appendicitis from 2006 to 2019 was performed. All patients operated by surgical interns were included. The sample was divided into 2 groups: LA performed during the first (G1) and last 3 months (G2) of their first year of residency. Demographics, operative variables, and postoperative outcomes were compared between groups. RESULTS: A total of 2009 LA were performed during the study period; 1647 (82%) were done by surgical interns. A total of 934 LA were performed at both ends of the year; 505 belonged to G1 and 429 to G2. Each surgical intern performed a mean of 40 LA. Demographics, complicated appendicitis rates, and presence of peritonitis were comparable between groups. Operative time was longer in G1 (G1: 61 vs. G2: 52 min, P<0.0001). Major morbidity (G1: 2.1% vs. G2: 3.4%, P=0.2), postoperative intra-abdominal abscess rates (G1: 2.8% vs. G2: 2.8%, P=0.66), median length of hospital stay (G1: 1.9 vs. G2: 1.8 d, P=0.59), and readmission rates (G1: 1.6% vs. G2: 2%, P=0.73) were similar between groups. There was no mortality in the series. CONCLUSIONS: LA can be safely performed by supervised surgical interns early in their training. Despite a longer operative time, postoperative outcomes were favorable and similar as those achieved at the end of surgical internship.